Racial and Geographic Disparities in Risk and Survival of Alzheimer's Disease and Related Dementias

阿尔茨海默病和相关痴呆症的风险和生存率存在种族和地理差异

• 批准号: 10631111
• 负责人: IGOR AKUSHEVICH
• 金额: $ 72.36万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10631111
• 关键词: Address; Adherence; Age; Algorithms; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Anesthesia procedures; Assessment tool; Behavior; Behavioral; Cause of Death; Code; Cognitive; Data; Data Set; Databases; Death Certificates; Dementia; Development; Diagnosis; Disease; Disparity; Elderly; Epidemiology; Ethnic Origin; Evaluation; Excision; Genetic; Geographic Locations; Geography; Goals; Habits; Health; Health Care Costs; Healthcare; Heterogeneity; Incidence; Income; Individual; Institute of Medicine (U.S.); Insurance Coverage; Joints; Literature; Longevity; Measures; Mediator; Medical; Medicare; Methodology; Onset of illness; Outcome; Patient Care; Pattern; Persons; Pharmacological Treatment; Population; Population Group; Population Heterogeneity; Prevalence; Preventive care; Primary Prevention; Procedures; Process; Public Health; Race; Research; Review Literature; Risk; Risk Factors; Role; Rural; Secondary Prevention; Series; Severities; Severity of illness; Subgroup; Telephone Interviews; Testing; Time; Time trend; cognitive function; cognitive interview; cognitive testing; comorbidity; dementia risk; design; ethnic disparity; geographic disparity; health assessment; health difference; health disparity; improved; insight; modifiable risk; mortality; nonalzheimer dementia; nursing home length of stay; polygenic risk score; predictive modeling; public health intervention; racial discrimination; racial disparity; racial population; resilience; sex; sex disparity; socioeconomic disparity; socioeconomics; tertiary prevention; treatment pattern; trend

Abstract There exists a limited number of studies that assess health disparities in Alzheimer’s Disease (AD) and even fewer for non-AD dementias. Insight from existing literature and our preliminary studies suggest that the most essential health disparities in Alzheimer’s disease (AD) and related dementias (ADRD) are related to race/ethnicity effects in AD risk and strong geographic gradient in mortality from AD. Our preliminary studies showed significant gaps between incidence rates for different race groups and mortality rates between East and West coast populations. In addition less significant disparities related to effects in rural/urban subpopulations and differences in survival from AD/ADRD were also identified. Detailed epidemiologic descriptions of these disparities, especially incorporating subgroups of AD-related dementias (ADRD), are lacking and the role of behavioral factors, comorbidity, time-dependent cognitive trajectories, and genetic effects in the developments of AD/ADRD are not sufficiently evaluated. Thus, there is a critical need to quantitatively describe the persistent disparities in the AD/ADRD outcomes and clarify the role of the multiple contributing factors. Our preliminary studies proved the ability to extract high-quality measures of the factors to be studied from the three datasets to be used in this study: 5%-Medicare, HRS-Medicare, and SEER-Medicare as well as Multiple Cause of Death database. Research in the project will be focused on i) re-evaluation of the disparities by calculating them with better accuracy and addressing limitations of our preliminary analyses, ii) multiple analyses designed to explain these disparities by analyzing the effects of potential mediators, iii) incorporating recent advanced methodological approaches such as a new partitioning approach for the decomposition of an overall trend into its causal components for analyses of these disparities in high volume data, and iv) incorporating new concepts for the explanation of these disparities, such as the contribution of over/underdiagnoses, heterogeneity in disease severity at time of diagnosis, analyses of patterns of conditions related to AD and ADRD, and the contribution of AD resilience to these disparities. Four Specific Aims planned in this study will deal with i) epidemiology of AD/ADRD, ii) behavior factors and comorbidity, iii) cognitive status and the effects of diagnosis severity and over/under diagnosis, and iv) genetic effects and cognitive resilience. The completion of these Aims will results not only in robust estimates of the disparities in AD/ADRD outcomes in diverse populations, but also, ultimately results in improvements in public health that can be achieved through reducing the identified disparities in AD/ADRD using targeted information based on the in-depth analyses conducted in this project. The expected outcome will be detailed disease-specific information presented in a quantitative form that provides the contribution of each studied factor to race/income-related health disparities in U.S. older adults. We will uncover the barriers in health-care provision that can be further used for improving primary, secondary, and tertiary prevention in the U.S. resulting, in their turn, in improved survival and higher life span.

抽象的 存在有限的研究，这些研究评估了阿尔茨海默氏病（AD）甚至 非AD痴呆症的较少。现有文献和我们的初步研究的见解表明，最多 阿尔茨海默氏病（AD）和相关痴呆症（ADRD）的基本健康分布与 AD风险中的种族/民族影响在AD死亡率中的强大地理梯度。我们的初步研究 在不同种族组的发病率之间和东方的死亡率之间显示出很大的差距 西海岸人口。此外，与农村/城市亚种群的影响有关的差异较小 还确定了与AD/ADRD的生存差异。这些详细的流行病学描述 缺乏差距，尤其是与广告相关痴呆症（ADRD）的差异，并且缺乏差异 行为因素，合并症，时间依赖性认知轨迹和遗传效应 AD/ADRD的评估不够充分评估。这是迫切需要定量描述持久性的 AD/ADRD结果的差异，并阐明了多个促成因素的作用。我们的初步 研究提供了从三个数据集研究要研究的因素的高质量测量的能力 在这项研究中使用：5％ - 医疗，HRS-Medicare和Seer-Medicare以及多重死亡原因 数据库。项目中的研究将重点介绍i）通过计算分配来重新评估分布 更好的准确性和解决我们初步分析的局限性，ii）旨在解释的多次分析 这些分布通过分析潜在介体的影响，iii）最近先进的 方法论方法，例如将整体趋势分解为新的分区方法 它用于分析这些分布的大量数据的因果成分，iv）编码新概念 为了解释这些分布，例如过度/诊断不足的贡献，异质性 诊断时的疾病严重程度，与AD和ADRD相关的条件模式的分析以及 AD弹性对这些分布的贡献。在这项研究中计划的四个具体目标将涉及i） AD/ADRD的流行病学，ii）行为因素和合并症，iii）认知状况以及诊断的影响 严重程度，诊断范围内/之下，iv）遗传效应和认知弹性。这些目标的完成 不仅会在潜水员种群的AD/ADRD结果中的分布情况下进行稳健的估计，还将结果 最终导致公共卫生的改善，可以通过减少确定的分配来实现 在AD/ADRD中，基于该项目中进行的深入分析的目标信息。预期 结果将是以定量形式提供的详细特定疾病特定信息 在美国老年人中，每个研究的因素对种族/收入相关的健康差异的贡献。我们将发现 医疗保健条款的障碍，可进一步用于改善初级，次要和第三级 在美国预防，随着他们的生存和更高的寿命而导致。